Replacing Multiple Teeth

Imagine this: An implant surgeon is performing a thorough examination of your mouth. The surgeon rotates your jaw from side to side and up and down, looking for the optimal sites in which to place dental implants — and the proper size, shape and orientation for the implants to have. He or she may test several alternatives, considering the underlying anatomical structures, and the bone density and quality that the examination reveals. Finally, a surgical plan is developed: This includes a set of precise specifications for implant position, size and depth, and a template for creating a perfectly fitting set of replacement teeth. But no invasive procedures of any type have been performed so far. In fact, you aren't even present.

Welcome to the world of computer-guided dental implant surgery. What we have described is one step in the process that allows you to receive a set of replacement teeth with the minimum amount of surgery (and time spent in the dental chair), and the maximum level of preplanning foresight. It can result in faster overall treatment time, less discomfort, and an outcome that pleases everyone. Let's look a little more closely at the entire process of computer-guided implant surgery — a procedure at the forefront of dental implant technology.

The First Phase: Making A Virtual Model

It all begins with a complete examination and modeling of your existing teeth, gum and jaw structures. In many cases, a physical impression (replica) of the jaws is made, which will aid in planning the location of the new teeth. But the modeling doesn't stop there: A high-tech, three-dimensional CT (computed tomography) scan is also performed. This allows us to examine the structures (including bone, nerve tissue and sinus cavities) which lieinside the jaw. It is often accomplished using “cone-beam” CT technology, in which the scanning device quickly captures a complete digital image of internal structures as it rotates around your head.

The next step of the process relies on powerful computers and sophisticated software to take the raw CT scan data and translate it into a 3-D model of the jaw. This virtual model can be manipulated on a computer screen — rotated, measured, even “operated” on — so that we can visualize the placement of dental implants and determine their optimum position with a high degree of accuracy. Using this technology, it's now possible for us to evaluate anatomical structures virtually — structures it once would have taken surgery to reveal — and to plan out the implant procedure accordingly.

The 3-D model we have developed is then used for two purposes: to create a precise guide for the implant surgery, and to allow the dental laboratory to pre-manufacture a set of replacement teeth that will fit precisely in the jaw. An advanced set of CAD/CAM (computer aided design/manufacture) processes is used to generate the physical objects — in this case, the surgical guide and the prosthetic teeth. Depending on your individual situation, the new teeth may be attached the same day as implant surgery, or after a healing period of 6 to 12 weeks. In either case, our precision modeling ensures that they will fit perfectly with the implants and the jaw.

Implant Surgery: Following the Plan

The implant surgery itself is typically performed under local anesthesia, and often requires no sutures (stitches). In the surgical procedure, the template we have produced (which resembles a nightguard or athletic mouthguard) is securely (but temporarily) fixed in position on the jaw. The openings in this template form precise guides for the placement of the implants — accurate in terms of position, width and depth. In fact, the implants fit so perfectly into these prepared sites that we can have new teeth placed the same day as implant surgery.

Since so many of the details have been accomplished in the planning stages, computer-guided implant surgery is typically uneventful for the patient. It can result in shorter time in the chair, less discomfort during recovery — and a highly pleasing result. It has even been called the most significant innovation in implant technology since osseointegration — the fundamental process by which a dental implant becomes fused with the bone.

If you have several missing teeth, dentistry offers three time-tested ways of replacing them: Dental implants, removable partial dentures, and fixed bridgework. Only one of these, however, will give you the security of a lifetime replacement — while preventing bone loss in your jaw: dental implants.

Dental implants stay securely anchored in your jawbone, for tooth replacement that looks and feels completely natural. Partial dentures, on the other hand, need to hook onto existing teeth, which can stress those teeth over time and cause them to become loose and even fall out. Fixed bridgework, likewise, can weaken the natural teeth that are used as supports: In order to hold a bridge in place, we need to file down and crown (cap) two or more natural teeth — at least one on either side of the gap left by a missing tooth. This may cause those support teeth to become more susceptible to decay or need root canal treatment. Implants never decay or need root canal treatment because they are made of titanium, a highly biocompatible metal.

How It Works

Dental implants are placed in your jawbone, where they act as roots for your replacement teeth. They are not visible because, just like natural tooth roots, they lie beneath the gum line. Only the lifelike dental crowns that are attached to them are visible to you or anyone else. The implants will actually fuse to your jawbone through a process known as osseointegration. The attachment formed will be permanent.

You do not necessarily need one implant for every tooth you are replacing. If the teeth you lost were all right next to each other, we may be able to create a dental bridge using implant teeth rather than natural teeth as supports. To do this, we will place implant teeth on either side of the gap left by your missing teeth. The remaining space between the implant teeth will be filled in with as many dental crowns as you need to bridge the gap. In other words, you will have a row of completely convincing prosthetic teeth, but only some of them will have implant “roots” beneath them.

If your missing teeth are scattered throughout your mouth, however, you may need to have individual implants placed for each one, or a combination of bridgework and single implants. We will go over all of your options in detail with you.

What to Expect

Dental implant surgery is a simple, routine procedure carried out in the dental office under local anesthesia in most cases. If you need to have failing teeth removed, that will be done first. After numbing the area, implants will be placed in your jaw at precisely planned angles and positions to maximize support and avoid anatomical structures such as nerves and sinuses. Depending on how many implants you need, the surgery can take anywhere from one to three hours. Most people who have dental implants placed find that any post-operative discomfort can be managed with over-the-counter anti-inflammatory medication such as ibuprofen or acetaminophen. Some don't need any medication at all.

Usually, the implants will be left to heal for several months before any teeth are attached. During this time they will complete the process of osseointegration. You will need to go easy on your new implants during this crucial healing phase to ensure the best results. We will advise you as to what foods you should temporarily avoid. Of course, once the implants have fused and the permanent crowns are attached, you will be able to eat anything you want! At that point, the only thing you will need to do is take care of your implant teeth just as you would your natural teeth — with regular brushing, flossing, and periodic professional cleanings at the dental office. That is the best way to ensure your implants last for a lifetime.

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